nutrition

While there is still no concrete answer as to why some do not develop age-related macular degeneration (AMD) and other’s do, significant studies have proven the importance of a healthy diet and the mitochondria.

AMD is the leading cause of vision loss for those over 60 years of age in the developing countries. For decades we have studies that show the genetics and environmental factors associated with AMD. There have been over 20 genetics modification associated with AMD but there is no single gene that “causes AMD in all cases.” The genes most highly associated with AMD are found in the complement system, an important system related to controlling the inflammation in our body. A change in the complement factor H (CFH) gene from a low risk gene to a high risk gene has been associated with 43% of those developing AMD.

However, some people who have this high risk CFH gene but never develop AMD. This leads us to believe that the genetics are not the entire answer. The other factor has to do with the environment. Smoking is the leading risk factor, along with aging, exposure to sunlight and higher body mass index (obesity). But again there are obese people that smoke and never develop AMD. So, while the environmental risk factors are important, they do not answer the entire question of “why do some people get AMD but others do not?”

Recently, researchers have recognized that a major factor in the dry form of AMD is that the retinal cells begin to die off. Therefore, they have looked at important factors that keep cells alive. The mitochondria are one of the most important elements that protect the cells in the body. These subunits or organelles, produce energy for the cells, acting like batteries for the cells. And just like the batteries in a flashlight – if the batteries are not working then the flashlight dies. The same thing happens with cells – when the mitochondria are not healthy, then the cells eventually will die. Therefore to protect ourselves, it is important to keep the mitochondria healthy. One way to do this is to eat healthy foods. Over the past 20 years, the National Eye Institute (NEI) has conducted a series of studies that have identified foods and supplements that are good for the retinal cells and also the mitochondria.

The National Eye Institute has recommended that people who are high-risk for developing AMD eat diets rich in green leafy vegetables, whole fruits, any type of nuts and omega 3 fatty acids. Many of these foods have anti-oxidant properties that help to “turn off” genes involved with inflammation, an important factor of retinal diseases. Salmon, mackerel and sardines have the highest levels of omega-3 fatty acids. An analysis that combined the data from 9 different studies showed that fish intake at least twice a week was associated with reduced risk of early and late AMD. Other studies show that Omega-3 fatty acids improve mitochondrial function, decreases production of reactive oxygen species (free radicals that damage cells) and leads to less fat accumulation in the body. The green leafy vegetables contain important protective macular pigments (carotenoids) called lutein and zeaxanthin that reduce the risk of AMD by 43%. High levels of lipid or fat deposits in the body (obesity) can “soak-up” the lutein and zeaxanthin so that they are not available to protect the retina.

The goal is to increase the omega-3 fatty acid and carotenoid levels to protect the eye. Below is a list of foods that are eye healthy:

Foods that have lutein or zeaxanthin:

– 6mg/d of lutein and zeaxanthin – decreased

– Lutein/zeaxanthin content – ug/100g wet weight

– Kale, cooked – 15,798

– Spinach, raw – 11,935

– Spinach, cooked – 7,053

– Lettuce, raw – 2,635

– Broccoli, cooked – 2,226

– Green peas, cooked – 1350

Source: Johnson, et al 2005 Nutr Rev 63:9

To help kickstart an eye healthy diet, here is a list of “eye-healthy recipes” that provide nutritional support for the mitochondria and retinal cells.

The following is a survey done by Essilor (a French company that produces ophthalmic lenses along with ophthalmic optical equipment) and a large marketing research firm in the UK, YouGov. While the focus in on people living in the UK, the results would probably be similar to the US population. Even with increased access to the Internet, many people are still not aware of the risks associated with eye disease and what they can do to help retain their vision. Increased awareness of informational resources are important for saving vision.
There are a number of websites with easy to understand information about taking care of your vision that I have listed under Resources to Help Save Vision at the bottom of this article. And while there are eye diseases that are hereditary, you can slow the onset and progression by making good lifestyle choices about smoking, diet and exercise. Your eye care specialist is also an excellent source of information about what you can to do reduce your risk of vision loss, at any age.

Increased Awareness for Saving Vision

A YouGov poll conducted with Essilor reveals that most Britons are unaware of damage to their eyes by surrounding objects, activities, and devices. This widespread lack of awareness means fewer people seeking methods of prevention and avoidance, and for those that are aware of risks, most are not informed of existing preventative measures.

The poll has shown* that many British people remain uninformed about the various ways in which eyes are damaged by common daily factors, despite evidence that eye health is affected by blue light, UV rays (reflected from common surfaces), diet, obesity, and smoking.
Of the 2,096 people polled, the percentage of respondents aware of the link between known factors affecting and eye health were:

Poor diet – 59%

Obesity – 35%

Smoking tobacco – 36%

UV light, not just direct from the sun but reflected off shiny surfaces – 54%

Blue light from low energy lightbulbs and electronic screens – 29%

More than one in ten people were completely unaware that any of these factors could affect your eyesight at all.
72% of respondents own or wear prescription glasses but only 28% knew that there were lenses available (for both prescription and non-prescription glasses) to protect against some of these factors; specifically, blue light from electronic devices and low energy light bulbs, and UV light from direct sunlight and reflective surfaces.

76% admitted they haven’t heard of E-SPF ratings – the grade given to lenses to show the level of protection they offer against UV.

Just 13% have lenses with protection from direct and reflected UV light, and only 2% have protection from blue light (from screens, devices, and low energy bulbs).

Poll results showed that younger people were most aware of the dangers of UV and blue light, yet least aware of how smoking tobacco and obesity can affect your eye health. Within economic sectors, middle to high income people are more aware of the effects of smoking & obesity on eyesight than those with low income –

39% of people with middle to high income compared to 33% of people with low income are aware of the impact of smoking tobacco.

38% of people with middle to high income compared to 31% of people with low income are aware of the impact of obesity.

Awareness of the impacts of smoking and obesity on eye health is significantly higher in Scotland (47% & 49% respectively) than anywhere else in the UK (35% & 33% in England and 40% & 38% in Wales).
Essilor’s Professional Relations Manager, Andy Hepworth, has commented: “The lack of awareness about these common risks to people’s eyes is concerning. Not only would many more glasses wearers be better protected, but also many people who do not wear glasses would likely take precautions too, if made aware of the dangers and the existence of non-prescription protective lenses.”

For more information on the protection offered from blue light and UV through specialist lens coatings, for both prescriptions and non-prescription glasses, please see here for UV & Blue Light Protection options.

*All figures, unless otherwise stated, are from YouGov Plc. Total sample size was 2,096 adults. Fieldwork was undertaken between 21st and 24th August 2015. The survey was carried out online. The figures have been weighted and are representative of all GB adults (aged 18+).

The more you know about cataracts, the easier it is to focus on cataract prevention.

What is a cataract?

At birth, with rare exceptions, most of us arrive in the world with a clear crystalline lens within each eye. The pathway of our visual images start with light passing through the cornea (the clear front window of the eye), through the pupil (the opening in the center of the iris, or colored portion of the eye) and through crystalline lens which functions to focus light onto the center of the retina (the film of the eye). The retina, via the optic nerve, will then transmit visual images to the brain. When the crystalline lens becomes opacified (cloudy), this system becomes disrupted, and vision becomes impaired. Opacification of the crystalline lens is called “cataract”, and there are many variations in appearance and type and many causes and can present at any age. The word cataract originates from the Greek word “cataracta”, which means waterfall. The ancient Greeks used this term as they noticed a similarity in the appearance of the white opaque rushing water of a waterfall and the appearance of a white mature cataract.

To understand the different types of cataracts and causes, it is important to understand the anatomy of the lens. Using a metaphor, the lens anatomy can be compared to a Peanut M&M candy™. There is an outer candy coating (the lens capsule), a chocolate layer inside (the lens cortex), and a peanut in the center (the lens nucleus).

The most common cause of a cataract is an age related nuclear clouding which is due to long term accumulation of metabolic and oxidative waste products within the lens and possibly UV-B/Sunlight light exposure. Cortical clouding (within the cortex of the lens), due to similar causes, is also a common cause of an age related cataract.

Cataracts can occur earlier in life with poorly controlled diabetes resulting in cortical and nuclear cataract. Patients who are exposed to steroid medications in any form (orally, topically as eye drops, skin creams etc.) are at an increased risk to develop a posterior subcapsular (PSC) cataract which occurs on the posterior lens capsule. PSC cataracts can have a much more abrupt and earlier onset in life than nuclear or cortical cataract. Smoking has also been known to predispose patients to formation of a PSC cataract. Other less common varieties of cataract can occur with any trauma to the eye or even present at birth as a congenital cataract with a large variety of causes.

What can be done to prevent cataracts?

I often joke with patients that a cataract is such a common occurrence that just like birth, death, and taxes, it is an issue we must all face at some juncture in life (hopefully later than earlier). I am often asked if there are any dietary measures or vitamin supplementation to reduce the formation of a cataract, however this is not as well studied as the use of vitamins in the prevention of macular degeneration. Several scientific epidemiological studies following populations over many decades have shown some merit however that using multivitamins regularly (Vitamin B6 and B12, Vitamin C, beta carotene, antioxidants and possibly lutein and zeaxathin) can reduce the degree of lens opacification over time. As with all medications, you should consult with your physician before deciding to use any vitamin supplementation to clarify if you have any contraindication to using them.

There is conflicting evidence regarding the role of UV-B exposure in sunlight as a causative agent for cataracts. There is some support that using sunglasses on a regular basis to block UV-B light may help to reduce cortical cataract formation. Smoking cessation can also help to reduce the formation of cataract. If a patient is diabetic, strict blood sugar control is also an important measure to reduce the formation of a cataract. If possible, reducing or avoiding the use of steroid medication can reduce the formation of a PSC cataract.

What can be done if a cataract is worsenening and glasses cannot help improve vision significantly?

If you are experiencing gradual painless loss of vision, you should consult with your ophthalmologist as cataract can be a common cause. If you are found to have cataract formation, there is generally a shift in the glasses prescription in the early stage. Having your glasses prescription checked to see if your vision can be improved with glasses is the first step in determining how significant your cataract has become. If glasses are not able to sufficiently improve your vision and your daily activities are affected by the decrease in vision your experience, you may be a candidate to have cataract surgery.

Modern cataract surgery has improved a tremendous degree compared to decades earlier. It is the most common and successful surgery in the world, and is typically performed on an outpatient basis with topical anesthetic and often without any sutures or eye patch. Prior to surgery the pupil is dilated, and once in the operating room, a small self-sealing incision is made on the side of the cornea. The surgeon then makes a circular opening in the anterior lens capsule (the candy coating of the peanut M&M), and uses an ultrasound instrument to emulsify and vacuum out the nucleus (the central peanut), and remove the cortex (the chocolate layer). The inside of the lens capsule is polished and an intraocular lens is folded and introduced into the eye through the corneal incision and seated into the remaining lens capsule to conclude the surgery.

Prior to surgery, measurements are taken to determine the power of lens necessary to achieve the best vision after surgery based on the curvature of the cornea and anterior-posterior length of the eye. Intraocular lenses (IOLs) can potentially have several features depending on a patient’s needs. The most common IOL used is a monofocal lens, which does not typically require an additional out of pocket expense. This lens is chosen to have a point of focus either for distance vision (driving, TV) or near vision (reading), but not both. Typically patients who have the monofocal lens will choose to have distance focus and use reading glasses for near vision. There are multifocal/accommodating IOLs available for patients who are appropriate candidates, to allow the patient a larger range of vision at far, near and intermediate (computer) distance and may allow great independence from glasses. There are still other IOLs which can correct astigmatism (a special type of glasses prescription) at the time of cataract surgery. After discussion of the patient’s needs and preferences, the surgeon can best advise their patient regarding which type of IOL may best suit them.

Can dinner really be delicious medicine for our eyes?

Recent studies have shown compelling evidence that specific nutrients support eye health.* When a vitamin or mineral is given as a supplement, are there the supporting micronutrients and enzymes required for optimal utilization of that supplement by our bodies? Is a nutrient more bioavailable and/or more beneficial to our health as a foodstuff than as a supplement? Are there unintended effects from supplements that are not present when the nutrient is derived from a food source?**

Despite the many thought provoking questions, I personally take supplements as I feel it is difficult to acquire the nutrients strictly through food. Dietary preferences and requirements influence our everyday food choices as well as the quality of food available at our local grocery stores. Thoughtfully designed, well-sourced supplements have been shown to enhance eye health and general well being.Here are some key nutritional principles which should be kept in mind to maximize the nutrient availability to our eyes and bodies from the foods that we eat:

1. Bioavailability: Vitamins A, D, E and K are fat soluble; the vitamin B-complex and vitamin C are water soluble. Dietary fats aid in the transport of fat soluble vitamins. Of particular importance to eye health are the fat soluble carotenoids in the vitamin A family, lutein and zeaxanthin. Carotenoids are the red, orange and yellow pigments found in fruit and vegetables such as kale, spinach, corn, apricots and orange bell peppers. To maximize their nutritional benefit, combine foods rich in carotenoids with a healthy source of fat such as olive oil, avocados or walnuts. Egg yolk contains the most bioavailable source of lutein and zeaxanthin and is preferentially deposited in the macula.

2. Nutrient Synergy: Nutrient synergy is the interaction of two or more nutrients that work together to achieve a greater effect than a single nutrient alone could. Foods have a vast array of micronutrients. We know that spinach contains a high level of lutein; however, we don’t know precisely how all the nutrients in spinach work together to promote eye health. Epidemiological studies show people who eat spinach have a lower risk for developing Age-related Macular Degeneration (AMD). Levels of lutein and zeaxanthin in the macula can be measured and low levels are a predictor for the risk of developing AMD.

4. Cooking Techniques: Steaming, sautéing or pureeing will break down the plant cell walls increasing the body’s access to the lutein found in dark leafy greens. Cooking tomatoes will increase the availability of lycopene. Heat, however, diminishes the amount of vitamin C present. To maximize lutein and vitamin C, consume both fresh and cooked vegetable sources. Excessive heat and lengthy cooking times diminish vitamin content (mineral content will remain intact, however).

5. Whole Foods:Whole foods have benefits such as soluble and insoluble fiber which help to regulate blood sugar. Foods high in fiber have been shown to decrease total cholesterol, triglycerides and VLDL levels. Fiber supports gut health which is integral to nutrient absorption.

6. Select Eye Nutrient Dense Foods: Studies have highlighted lutein+zeaxanthin, the omega-3 fatty acids balanced with omega-6 fatty acids, the vitamin A family, the antioxidant vitamins C and E, as well as the mineral zinc. There a number of other nutrients that play a role in eye health including B vitamins, selenium and other plant based antioxidants. Knowing the food sources of these important nutrients will help you to make better food choices for eye health.

How does this sound for dinner tonight? Grilled wild salmon on a bed of lightly sautéed spinach with caramelized onions!

Spinach and kale aren’t the only things to watch in your diet. Eating low glycemic foods may slow the development and progression of AMD. The glycemic index measures how quickly carbohydrates get glucose (sugar) into the blood stream. People with diabetes will find this familiar. High glycemic foods like potatoes, white rice, processed foods like cakes and crackers and cereal raise the blood glucose level. Low glycemic foods include vegetables and beans.from www.crossfithoboken.com
Several years ago researchers at Tufts University found that mice fed a low glycemic diet developed fewer and less severe age-related lesions in the retina than mice fed the higher GI diet. When lesions like this develop after age 60 in humans, they are the earliest warning sign of age-related macular degeneration. Earlier studies in humans resulted in similar observations.

*Here are some tips from Harvard University for low-glycemic eating.

1. Eat a lot of non-starchy vegetables, beans, and fruits such as apples, pears, peaches, and berries. Even tropical fruits like bananas, mangoes, and papayas tend to have a lower glycemic index than typical desserts.

2. Eat grains in the least-processed state possible: “unbroken,” such as whole-kernel bread, brown rice, and whole barley, millet, and wheat berries; or traditionally processed, such as stone-ground bread, steel-cut oats, and natural granola or muesli breakfast cereals.

3. Limit white potatoes and refined-grain products, such as white breads and white pasta, to small side dishes.

4. Limit concentrated sweets – including high-calorie foods with a low glycemic index, such as ice cream – to occasional treats. Reduce fruit juice to no more than one-half cup a day. Completely eliminate sugar-sweetened drinks.

5. Eat a healthful type of protein, such as beans, fish, or skinless chicken, at most meals.

6. Choose foods with healthful fats, such as olive oil, nuts (almonds, walnuts, pecans), and avocados, but stick to moderate amounts. Limit saturated fats from dairy and other animal products. Completely eliminate partially hydrogenated fats (trans fats), which are in fast food and many packaged foods.

7. Have three meals and one or two snacks each day, and don’t skip breakfast.

8. Eat slowly and stop when full.

*Adapted from Ending the Food Fight, by David Ludwig with Suzanne Rostler (Houghton Mifflin, 2008)

Last week we reviewed the rainbow of fruits and vegetables you can eat to help with eye health. But you don’t need to limit yourself – enjoy a rainbow of nuts, whole grains and beans as well.

Photo by zcool.com.cn

A reason some people avoid nuts is the number of calories found in nuts. However, a report published in the American Journal of Clinical Nutrition found that adults who incorporate nuts into their diets don’t have to limit their consumption. A review of 31 studies about eating nuts found that people who added nuts to their diets and who replaced other foods with nuts lost more weight, an average of almost one and half pounds. Nuts have also been shown to be beneficial for stress reduction, heart health, various cancers, cholesterol, brain health and eye health.

Eating more whole grains makes your diet healthier because they are filled with nutrients including protein, fiber, B vitamins, antioxidants, and trace minerals (iron, zinc, copper, and magnesium). A diet rich in whole grains has been shown to reduce the risk of heart disease, type 2 diabetes, obesity, and some forms of cancer.

Beans, lentils and other nutritious legumes are the best sources of lean vegetarian protein. They made up of high-quality carbohydrates that are rich in fiber, zinc, vitamin B6, folate, magnesium, iron, and potassium. These protein-packed, low-fat nutrients can help with osteoporosis; improve heart-health, colon and bowel health; reduce the risks of cancer and age-related macular degeneration; control blood sugars, fight free radicals and even help with weight loss.

RED

Red adzuki bean

Pinto beans

Kidney beans

Pecans

Buckwheat

Amaranth

Quinoa

Barley

ORANGE/YELLOW

Almonds

Cashews

Millet

Chickpeas

Butter beans

GREEN

Lentils

Mung beans

Pistachios

Pumpkin seeds

Lima beans

Edamame

Sunflower seeds

BLUE/PURPLE

Flaxseeds

Walnuts

Chestnuts

Black beans

Quinoa

Black and wild rice

Rye

WHITE

Soy beans

Garbanzo beans

Rice

Barley

Sesame seeds

Navy beans

Oats

Quinoa

To learn more about the benefits of specific nuts, whole grains and beans, go to The World’s Healthiest Foods. The site is filled with nutritional information, history and recipes for a wide variety of foods from around the world.

Susan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Last week a study that appeared in the Annals of Internal Medicine (AIM) showed that fish oils such as omega-3 don’t reduce the risk of heart disease. It caused quite a stir, as we have been told for years, by organizations like the American Heart Association that we needed to increase our intake of omega-3. For some people that meant taking supplements instead of eating flax seeds, walnuts, sardines or salmon, just a few of the sources of omega-3.

In May of 2013 the results of the AREDS II study on eye supplements found that while lutein and zeaxanthin may be helpful in helping vision, omega-3 did not have a positive effect over five years.

In both of these studies they are referring to omega-3 supplements. This does not mean you should give up eating fish, or other sources of omega-3. To derive the benefits of omega-3 you need to get it from the source – directly from the food you eat, so it is still advised you eat fish as part of a healthy diet.

If you do use supplements check with your doctor to make sure they are right for you. A doctor can help you determine what, if anything you might need, making a decision based on your diet, medical history and any medications you might be taking.

2. Take time to blink – On an average you blink about 15 – 20 times a minute. However, that rate drops by half when viewing text on a screen. Try using the 20/20/20 rule when staring at a screen: Every 20 minutes, look 20 feet away for 20 seconds so you can blink naturally and give your eyes time to relax.

3. Wear sunglasses and a hat – Exposure to ultraviolet (UV) rays can deteriorate vision over time, leading to cataracts and age-related macular degeneration (AMD). The American Optometric Association recommends sunglasses that block at least 99 percent of UVA and UVB radiation and that screen out 75 – 90% of visible light. And if you plan to spend a lot of time outdoors, it’s a good idea to get sunglasses with lenses that are polarized, which means that they’ve been treated to reduce glare. Since the sun doesn’t just affect your eyes from the front, try wearing a large brimmed hat to further protect your eyes.

4. Increase the seafood in your diet – Omega-3 fatty acids have been shown to bolster heart and brain health, as well as decrease your risk of eye disease. According to a study published in the 2011 Archives of Ophthalmology, women who ate canned tuna and dark-fish meat (mackerel, salmon, sardines, bluefish, swordfish) just once a week reduced their risk for AMD by 42%, as opposed to people that ate the same fish less than once a month.

5. Eat a rainbow – Eating a full rainbow of fruits and vegetables regularly helps give your body the nutrients it needs. In addition to fiber, vitamins and minerals, naturally colored foods contain what are known as phytochemicals, which are disease-fighting substances that also give fruits and vegetable their array of colors. Star nutrients are lutein and zeaxanthin—pigments found in such foods as dark, leafy greens, broccoli, zucchini, peas, and Brussels sprouts. Also important are antioxidants found in red foods such as strawberries, cherries, red peppers and raspberries, Orange foods have beta-carotene and include carrots, pumpkins, sweet potatoes and yams.

6. Use digital screens at a safe distance – The brightness and glare from computers, tablets, smartphones and televisions can lead to eyestrain after prolonged use. Recent studies have also shown ill-effects from the UV rays from these devices. Symptoms can include headaches, blurred vision, dry or red eyes and difficulty refocusing. Experts recommend keeping the computer screen at least an arm’s length away and that you hold a handheld device at least 16 inches from your eyes.

7. Contact lens solutions serve a purpose – While approximately 85% of contact lens wearers claim that they’re caring for their lenses properly, only 2% are according to a study out of Texas. The most harmful but common problem is moistening contacts with saliva instead of saline solution.

8. Make-up makeover – Replace tubes of mascara after three months, as it is a breeding ground for bacteria. Sharpen liner pencils regularly and while it is okay to line the base of your lashes, using the liner inside the lash line can block oil glands. Replace eye shadows yearly and don’t share your eye cosmetics.

9. Use protective goggles – According to a 2008 study from the American Academy of Ophthalmology and the American Society of Ocular Trauma, of the 2.5 million eye injuries in the US annually, nearly half happen at home. Sports activities are another cause of eye injuries, from contact sports to sports that use balls that could catch you unaware. When snowboarding or skiing remember to protect your eyes from the sun and wind with tinted goggles that have UV protection.

10. Have a yearly eye exam – Even if you don’t wear corrective lenses, adults should get a comprehensive eye exam (which includes dilating your pupils with drops) by age 40. After that a yearly eye exam is recommended to keep your eyes healthy and catch any changes in your eyes that may be indicators of eye disease. If you have a family history of glaucoma or age-related macular degeneration, or you have diabetes, you are at a higher risk for vision-related issues and your doctor may elect to see you more often. If you have symptoms such as persistent pain inside or behind your eyes, redness, or gradual loss of vision, make an appointment with your doctor immediately.